Smart Kids - Don't Go to Medical School! (Ep. 59)

Today is going to be a little bit of a different show. It's May of 2024 and college is getting out for the summer.

And I've had a couple of college students who have called asking to shadow because they're interested in becoming a doctor. You know, when I was a kid back in the nineties, becoming a doctor was what the smart kids wanted to do. And as I got to thinking about this and certainly welcoming the college students in to see what we do here, I was thinking, you know, if I were a college student and if I had one bit of advice to give to college students thinking about going to medical school.

In general, it would be don't. And really, there are three main reasons. It sounds terrible, but there are really three main reasons why I would say [00:01:00] that to a college student who is interested in science, interested in medicine, interested in helping people. First of all, getting your MD these days largely means you work for somebody else.

And that somebody else isn't your patients. The concept of private practice medicine is largely dead in the United States. Doctors do not work for themselves anymore. It's very rare for that to happen.

Most doctors are employed by some big hospital owned group or a large health system. And these hospital groups and health systems, many of whom have ties to private insurance [00:02:00] companies, are concerned with one thing, and it isn't patient care. It's maximizing profits. And if they're publicly traded, if it's a publicly traded company on the stock exchange where you can buy stock in these companies, they are legally obligated to maximize profits.

They're not legally obligated to provide quality health care. And what that's really done, the dissolution of private practice medicine and the takeover of medicine by the government. Third party payers that are focused on profit is that the doctor and the patient have largely become widgets on a factory line.

We are interchangeable pieces on a factory line that cranks out profits for the factory owners. Case in point, employed physicians now have quotas. They have a certain number of [00:03:00] patients that they have to see every hour. They have a certain ratio of complicated patients to simple patients that they have to see.

There's tons of documentation requirements in the list of requirements for employed physicians is exhausting. The amount of documentation that they have to, to get paid is exhausting. For my generation and older, this is not what we signed up for when we just decided to become physicians. We wanted to take care of patients.

And so you're seeing older physicians and I'm kind of on the, on the verge of the older doctor. Now, older physicians are starting to retire and the younger physicians that are coming out of training programs don't know any better. They learned under the auspices of limited work hours, they learned How to take care of patients with hospitalists who took care of the patients who were in the hospital while they were doing [00:04:00] something else.

They had sign offs where they would trade patients back and forth when their work hours were done. They were essentially trained to be cogs in a wheel. And that's very different from the way older physicians were trained. There's a difference from the way I was trained where Your patient was your patient and if they were sick at night on the weekend when you just worked 36 hours straight and somebody had a problem two hours later, they were still your patient.

You still were responsible for taking care of that person. And now you can argue back and forth is that, is it better for trainees? Is it better for patients if their doctors rested? I think absolutely it is. But there is a certain amount of training that has to be done and you can't expect. The same amount of training to be done in say for general surgery, five years at 80 hours a week versus what you did at five years at 120, [00:05:00] 130 hours a week.

It just isn't possible without massive shifts in how we train. And that's a whole different discussion. So point one is that Doctors don't work for themselves anymore. The second point is that unfortunately physicians largely have abandoned the scientific method and independent thinking. Doctors simply do not think like they used to.

We do not think like we used to. This goes kind of back to a little bit to the first point. The government and big insurance companies now dictate the care that patients receive. They pay for things that they approve of and they deny payments for things that they don't. That is effectively dictating care.

That is, that is practicing medicine. They'll say that it's not. But it is. The approvals and denials that these third party payers use [00:06:00] are based on protocols and algorithms. These are not based on a doctor's wisdom, a doctor's judgment and experience with that patient sitting in front of them in an examination room.

The doctor merely exists to provide a diagnosis, which is a numerical code that you have to send to an insurance company, and then An algorithm dictates a list of approved treatments for that diagnosis code that the insurance company pays for.

So hear that again. Algorithms and protocols dictate treatment that you and I receive for a given diagnosis. The doctor doesn't make the decisions anymore. An algorithm does. This is really scary and should be really scary because the less doctors think critically, the less we think critically when we're taking care of patients, the less we're able to think critically.

It's like lifting weights. If you don't lift weights, then [00:07:00] your muscles shrink and get weak and you can't lift as much weight. If you don't think critically and you're not in the habit of thinking critically, then when something bad happens that there's not a written protocol for, doctors don't know how to think critically and solve that problem.

And will blindly follow direction from some bureaucrat who sounds like they're smart and knows what they're doing. Anybody remember 2020? See how that turned out for everybody.

So, that, that is the, thinking is the second part.

The third part, and this is really kind of me reading the tea leaves in the spring of 2024, is that unless you are going to medical school to be a, an interventionalist, someone who works with their hands, a surgeon. An interventional cardiologist. Unless you're going to medical school to work with your hands, the chances of you having a job in 20 [00:08:00] years is very small.

And I'll tell you why. Being a doctor is about diagnosing disease, recommending treatment. Actually, being a doctor is about preventing disease. And when disease happens, diagnosing it. and recommending treatment. Diagnosis, the art of diagnosis that we're taught in medical school, is about recognizing patterns of symptoms that are associated with a given disease.

Once we recognize the patterns, then we come up with a list of possible diagnoses, rule those in or out, based on physical exam findings and other things that we see, test results, for example, and then coming up with a treatment. AI has not been around for very long and already AI is fundamentally changing many industries.

And if you think about medicine as [00:09:00] pattern recognition and following protocols, which is what it's turned into, Now, those are things that AI can do. And as, as it gets exponentially better with every day, pretty soon your Apple watch, your smart scale in your house, your digital thermometer, you combine all of that data together.

You talk to an AI and tell them what you're feeling and what's been going on and the AI spits out a list of diagnoses. You don't even need a doctor for that anymore. And the scarier thing about that is given that the third party payers are largely, these big companies are largely in control of the medical industry now, all they need to do is buy

the keys to an AI and then [00:10:00] the number of physicians that they need plummets overnight, because you don't need many doctors when you've got good AI and Oh yeah, you've got a bunch of allied health professionals, PAs, nurse practitioners and nurses that can double check signs and symptoms that can write prescriptions and.

And those allied health professionals, just from a cost standpoint, cost a lot less than a doctor does.

And so you've got kind of this perfect storm of, doctors who work for big companies that are concerned with making profits, who have learned to blindly follow protocols, but now the protocols are being Um, followed better by a machine and you've got allied health professionals who cost less who can oversee some of that.

You know, reading the tea leaves, you're going to have clinics that are staffed [00:11:00] by PA's nurse practitioners with maybe one doctor and an AI and everything's digital. And so, you're, I don't even know what the numbers are, 1, One internist or family practice doctor for 2, 000 people may go to a need of one internist or family practice doctor for 20, 000 people or 50, 000 people or 100, 000 people.

That narrows the need for those physicians, which were the bulk of doctors coming out of medical school, going into primary care. That narrows the need for those. Significantly. You know, don't get me wrong, medicine is a great field. I love what I do. I love the specialty that I'm in. Plastic surgeons who are in private solo practice or in a small group practice are kind of [00:12:00] dinosaurs.

We, we practice in a way that, you know, we're largely outside of the. insurance realm and our surgeons and are able to kind of be divorced from the insurance medicine as a whole, medicine itself has changed a ton in the almost 25 years since I finished medical school. And it's us, it's doctors that have allowed all this to happen.

We've, we've given away our profession. to insurance companies and hospital systems and big third party payers. And now, you know, we're on the verge of seeing the need for physicians in the United States decrease dramatically. So, if you are a college student, you're a high school student who is interested in going into medicine, I would say it is a fantastic field It's a long road to get wherever you're going, no [00:13:00] matter what, where you want to go.

But I would think about what you want to do really carefully and would argue that if you are going to do something that is not surgical, and you know that right off the bat, blood grosses you out. The thought of operating on someone makes you ill. I would seriously consider an allied health profession.

Go to PA school. They have flexibility in their, in their career choices. They can bounce between surgery and medicine. Become a nurse practitioner, become a nurse anesthetist, just become a nurse and do critical care medicine or, some other branch of nursing. Unless you go to medical school and become a surgeon, there's a very real chance that the need for those doctors is going to dramatically decrease and the availability of jobs in the [00:14:00] United States in the next 20 years may decrease significantly.

Sorry this has been a little bit of a gloom and doom podcast, but I felt like I had to kind of lay the tea leaves out and, and read the tea leaves here in the spring of 2024 with what I thought was going to happen because I've had a lot of college students who have been calling recently wanting to shadow and wanted to kind of get my thoughts down so that they're at least out there.

I may be a hundred percent wrong. We may look back at this, listen to this podcast, look at this video, and 10 or 15 years and laugh hysterically at what a moron I was, but I don't think so. So if you've got any questions, you got any suggestions for podcast episodes, you want to tell me how wrong I am. Um, actually don't send me an email.

If you want to tell me how wrong I am, you can keep that to yourself, but, uh, any questions or comments, you can always Suggestions for future shows, send them to media at drjasonhall. com [00:15:00] or shoot me a DM on Instagram or Twitter. I guess it's now X, but thanks for listening and we'll see you on the next show.